HIV is a fragile virus that can only be transmitted under specific conditions that allow contact with infected body fluids, including???

Infection occur after an exposure depends on ?

1. Duration and frequency of contact, 2. Volume of fluid in exposure, 3. Virulence (The ability of any agent of infection to produce diseas) and the concentration of the organism, 4. Host immune defense capability.

Medication use?

New born will receive?

Occupational Exposure?

What is recommended practice after an exposure? Mercy Policy, Iowa City for Questions, Contact Employee Health to determine risk and where to go from there. Concerns exist also about Hepatitis B and Hepatitis C exposure as well

All steps are required to?

Initial infection results in?

This is followed by a prolonged period during which?

HIV levels in the blood remains low even without treatment (happens after a few weeks and may last for 10-12 years) and few clinical symptoms are present. HIV REPLICATION IS STILL CONTINUING THOUGH! Still continuing w/o symptoms

3

Budding Process

2. HIV spreads throughout the body

Lymphoid tissue becomes an early reservoir for HIV/ HIV causes significant degenerative change in the lymph system/ Allows the viral particles to spill over into the blood --> leads to DECREASED IN IMMUNITY

3. HIV Spreads throughout the body

infects the monocytes/ infected monocytes move into tissues and become macrophages (phagocytic cells)/ These cells become "HIV factories" and can rupture, spreading newly formed HIV into the surrounding tissue: SKIN, CNS, LYMPH NODES, BONE MARROW, and LUNG.

Look at TIMELINE FOR THE SPECTRUM OF UNTREATED SPECTRUM OF HIV INFECTION

Stages of HIV Infection Acute Infection

Symptoms usually occur 1-3 weeks after an initial infection and last 1-2 weeks but can persist for months./ CD4+ T cell counts temporarily fall (that dip the chart) but quickly RETURN TO BASELINE/ Most symptoms are mild - may may mistaken for a COLD or FLU/ In a few people, neurologic complications may develop(meningitis, peripheral neuropathy, facial palsy, Guillain-Barre syndrome

DIAGNOSTIC CRITERIA FOR AIDS

LATE CHRONIC INFECTION

These criteria are more likely to occur when the immune system becomes severely compromised/ These opportunistic conditions generally do not occur in people with FUNCTIONING IMMUNE SYSTEM/ These infections can be severe, debilitating, and life-threatening

LATE CHRONIC INFECTION

Immune system is SEVERELY COMPRIMISED/ Increased amount of HIV in the blood/ Decrease in the lymphocyte/ Advance in tx have led to significant decreases in the rates of opportunistic diseases- successful tx of HIV helps to maintain the immune system and prevent infections and cancers.

What is Koposi's Sarcoma? (opportunistic diseases)

Often the presenting SYMPTOM of AIDS/ Most common CANCER FROM AIDS/ Manifest as firm, flat, raised or nodular hyperpigmented, multicentric lesions/ Diagnosed with BIOPSY OF LESIONS/ Treated with cancer chemotherapy, radiation of lesions, alpha-interferon or local radiation or cryotherapy (risk for bleeding) for skin lesions.

Herpes Virus Dx with?

Herpes Tx?

Look at Table

Summary of HIV pathogenesis

1. HIV enters the body through sexual, parenteral, or vertical route (born with it) 2. The virus preferentially infects CD4+ T-lymphocytes, or CD4+ T cells which play a critical role in immune function 3. Viral load progressively increase as more virus is produced 4. The number of CD4+ cells progressively Decrease to a point that immune function is compromised 5. When immunosuppression becomes profound (CD4 count <200) risk of opportunistic infections and malignancies increase dramatically

Who will get it free?

Diagnostic studies with HIV infection

Window period?

up to a 2 month time frame from infection before antibodies can be detected/ Now can be done with oral fluid and urine/ Newer tests are rapid -20 minute blood tests in the office setting- CDC recommends these

1st and 3rd trimester/ Risk Vs benefit

CD4+ T cell count

Viral load

to assess viral activity, clinical status and disease progression/ Counts the number of viral particles in a sample of blood/ Help to determine: when to initiate therapy. efficacy of therapy and if the CLINICAL GOALS ARE BEING MET, EVEN IF THE VIRAL LOADS ARE LOW, ITS STILL ABLE TO TRANSMIT

Phenotype assay?

Therapeutic Management Collaborative Care Focus

Monitor the disease PROGRESSION AND IMMUNE FUNCTION/ Initiate and monitor antiretroviral therapy/ Prevent the dev of Oppurtunistic disease/ Manage SYMPTOMS/ Prevent and treat the complications of tx/ Prevent TRANSMISSION OF THE DISEASE TO OTHERS

Resistance can happen?

Table

Why would they use combinations of drugs from different drug groups?

Various combination attack viral replication in several different ways to : Makes is MORE DIFFICULT FOR THE VIRUS TO RECOVER and IT DECREASED LIKELIHOOD OF DRUG RESISTANCE. And also virus mutates, may have different combination, more cost effective.

Prevention, diagnosis and treatment of opportunistic diseases have?

TABLE

What are the major problems with ART?

Resistance develops rapidly when they are USED ALONE OR INADEQUATE DOSES/ Need to use combination of 3 or more ART at FULL STRENGTH/ Dangerous interactions with PI's, NNRTI's and come commonly used meds, OTC meds and herbal therapy (ST JOHNS WORT INTERFERES WITH ART)

What are other issues?

Treatment protocol can reduce viral load by 90-99% in many cases, there are problems/ Some people with HIV will not experience dramatic response with ART and will cause feelings OF DESPAIR and FAULTY (why are we even trying this!)/ Many patients will not be able to use combination therapy because of? - expense, side effect, inability to adhere to REQUIRED SCHEDULES AND DIETARY CHANGES

Fusion Inhibitors (entry inhibitors)

Fuzeon

use for advanced HIV disease with evidence of resistance to other therapy/ can cause skin irritation at injection site, fatigue, nausea, insomnia, pneumonia, and peripheral neuropathy/ SUBCUTANEOUS INJECTION WITH ROTATION OF SITE/ Monitor for reactions at injection site, signs and symptoms of pneumonia, and changes in HIV lab studies (CD4+ counts, viral load)

Foscavir

PT and FAM teachings with ART meds

Ways to decrease risk for resistance?

Take at least 3 different ART drugs at a time/ Know what and how to take meds prescribed/ Take full dose on SCHEDULE/ If unable to take d/t side effects, call PCP/ understand the interactions with other meds/ understand "viral" load/ Low viral load does not mean ABSENCE OF DISEASE OF VIRUS -> STILL CAN SPREAD IT [refer page 15-23 on page 265]

Problems in developing vaccine?

HIV lives away from CIRCULATING IMMUNE FACTORS/ HIV mutates RAPIDLY/ 2 Strains of HIV (HIV 1&2) that causes AIDS and at least 9 families of HIV around the world/ Can only be tested in humans - ETHICAL ISSUES/ Vaccine will not replace current prevention methods-now need to decrease risk behaviors as no vaccine is likely to be found 100% effective/ Cultural CONSIDERATION IN OTHER COUNTRIES-FEMALE DOMINANT? LEWIS 259

Nursing Assessment

4 questions to ask?

1. Have you ever had a blood transfusion or used clotting factors? 2. Have you ever shared needles, syringes, or other injecting equipment with another person? 3. Have you ever had a sexual experience in which your penis, vagina, rectum, or mouth came into contact with another persons penis, vagina, rectum or mouth? 4. Have you ever had STD's? --LEWIS 15-23 TEACHING

Nursing planning/ Goals

Encourage patient to learn safer and healthier and less risky behaviours/ Adherance to medication regimes/ adequate nutrition status/ Prevention of opportunistic disease (reduced or eliminated )/ Prevention transmission of HIV to others/ Healthy and SUPPORTIVE RELATIONSHIPS/ Cope with the consequences of HIV/AIDS/ Maintain the best quality of life possible/ Come to terms with issues r/t disease, death and spirituality